DE: WC Adds P2P Conversation To UR Process

Dover, DE (CompNewsNetwork) - The Delaware Department of Labor, Office of Workers' Compensation, received requests from certified health care providers in the HCPS to have a "peer-to-peer" conversation with the reviewing like-specialist prior to the specialist issuing a non-certified determination as a result of a utilization review.  A carrier or self-insured employer ("payer") must request a utilization review any time the "payer" denies payment because they believe the treatment did not adhere to the Delaware Workers' Compensation health care practice guidelines.  Five guidelines have been in place since 5/23/08 - carpal tunnel, chronic pain, cumulative trauma disorder, low back, and shoulder.  The sixth guideline, cervical, went into effect on 6/1/09 … read more